Total laparoscopic splenectomy combined with pericardial devascularization has become an important surgical treatment for portal hypertension patients. Compared with the traditional open surgery, laparoscopic surgery has multiple advantages including precise operation, small trauma and quick recovery. Accurate preoperative evaluation, precise surgical operation and delicate perioperative management are still important parts in perioperative management of laparoscopic surgery. Preoperative reasonable and accurate individualized assessment, strict control surgical indications and contraindications are the important basis to ensure the perioperative surgery to be safe and rational; standardized and individualized surgical operation is the key for accurate vascular disconnection, reducing intraoperative bleeding and perioperative complications; the concept of fast-track surgery is conducive to the rapid recovery of patients with portal hypertension and reduce the operation related complications. Anticoagulant therapy is a safe and effective treatment to reduce portal vein thrombosis. It is an important task to strengthen the cooperation among different disciplines for the treatment of portal hypertension in the future.

Objective To evaluate radiofrequency ablation in anatomical hepatectomy.Methods The clinical data of 57 patients undergoing anatomical hepatectomy with radiofrequency ablation (radiofrequency ablation group) from Jul 2010 to May 2013 in Tangdu Hospital were compared with those 57 cases using traditional clamp crushing resection during the same period.Results There was no mortality perioperatively.Intraoperative duration of liver dissection,haemorrhage volume of liver dissection,blood transfusion volume,Pringle manoeuvre,postoperative alanine aminotransferase (ALT) in the third and fifth day in the radiofrequency ablation group were (65 ±30) min,(195 ± 107) ml,(150 ±80) ml,7 cases (12.3％),(309 ±226) U/L and (164 ±82) U/L respectively,which were statistically different from those of (50 ±40) min,(255 ± 180) ml,(205 ± 120) ml,45 (78.9％),(388 ± 174) U/L and (220 ± 156) U/L in clamp crushing resection group (seperately t =2.266,-2.158,-2.880,x2 =51.060,t =-2.090,-2.403,all P ＜ 0.05).Large branches of hepatic vein (caliber ≥ 7 mm) were injuried by mistake 7 times in radiofrequency group,there was no massive blood loss.Postoperative biliary fistula developed in two cases.There was no ablation included thrombus.In radiofrequency group,and Pringle manoeuvre was used in hemihepatic resection in 7 patients.Conclusions Radiofrequency ablation is not recommended to dissecting large caliber vessels (≥ 7 mm) for fear of causing thrombus.Radiofrequency ablation in anatomical hepatectomy,when used properly,is safe and effective.

Objective To establish a method of inducing dendritic cells(DC)from rat bone marrow cells in vitro,and identify the phenotype and function characteristics.Methods The rat bone malToW cells were collected and cultured in vitro under the condition of recombinant rat GM-CSF(rrGM-CSF)and recombinant rat IL-4(rrIL-4).After 2 weeks,the morphological character of DCs was observed under light microscope and scanning electron microscope.Expression of MHC-Ⅱ,CD80 and CD86 were detected by flow cytometry.The ability to stimulate allogenic T cells of the cultured DCs was detected by mixed lymphocyte reaction.Results DCs showed typical morphology with elongated dendritic processes under inversion microscope and scanning electron microscope.DCs at day 6 revealed immature phenotype,including MHC-Ⅱ(29.03 ±4.39)%,CD80(21.98±7.08)%and CD86(25.94±6.80)%.DCs at day 12 showed higher expression of MHC-Ⅱ(74.05±5.97)%,CD80(79.85±6.53)%and CD86(81.00±7.47)%,and stimulatory capacity of allogenic T cells,compared with that in DCs at day 6.Conclusion Matured DCs could be generated from rat bone marrow cells and attendance with rrGM-CSF and rrIL-4,which present the feasibility for further research on its application to allograft immunorejection.

Objective To investigate the clinical effect of laparoscopic splenectomy combined with pericardial devascularization for the treatment of portal hypertension.Methods The retrospective cross-sectional study was conducted.The clinical data of 310 patients with portal hypertension who underwent laparoscopic splenectomy combined with pericardial devascularization in the Tangdu Hospital of Fourth Military Medical University between January 2012 and June 2016 were collected.All the patients underwent laparoscopic splenectomy combined with pericardial devascularization.Observation indicators:(1) surgical and postoperative situations;(2) follow-up situations.Follow-up using outpatient examination and telephone interview was performed to detect the gastrointestinal rebleeding and postoperative survival of patients up to January 2017.Measurement data with normal distribution and skewed distribution were respectively represented as average number (range) and M (range).Results (1) Surgical and postoperative situations:all patients underwent successful operation.Twelve patients converted to open surgery due to intractable bleeding and 298 underwent totally laparoscopic splenectomy combined with pericardial devascularization.Average operation time,average volume of intraoperative blood loss,average time of gastrointestinal function recovery and average time of postoperative abdominal drainage-tube removal of 310 patients were 192.5 minutes (range,120.0-300.0 minutes),402.3 mL (range,150.0-1 200.0 mL),2.4 days (range,1.0-4.0 days) and 4.2 days (range,2.0-8.0 days),respectively.Among 11 of 310 patients with postoperative complications,1 died of acute severe hemorrhage of upper digestive tract,5 with intra-abdominal bleeding received successful hemostasis (3 undergoing reoperation and 2 undergoing conservative treatment),2 with pleural effusion were improved by thoracentesis and drainage,2 with pancreatic leakage and 1 with pulmonary infection were cured by conservative treatment.Other 299 patients didn't have postoperative complications.Duration of postoperative hospital stay of 310 patients was 6.4 days (range,5.0-9.0 days).(2) Follow-up situations:260 of 309 patients were followed up for 6-60 months,with a median time of 26 months.During the follow-up,1 patient died of acute portal vein thrombosis at 1 month postoperatively;15 with gastrointestinal rebleeding and melena were cured by conservative treatment;other patients had survival.Conclusion Laparoscopic splenectomy combined with pericardial devascularization for the treatment of portal hypertension is safe and effective.

Objective:To evaluate thrombo-pretreatment in AngioJet mechanical thrombectomy.Methods:68 acute DVT patients were randomized into two groups: thrombo-pretreatment with low-dose urokinase via popliteal vein before operation (experimental group)comparing with those undergoing upfront surgery.Results:After pretreatment, the immediate thrombus clearance grade in the experimental group was higher than that in the control group( Z=2.446, P=0.014), the procedure time was shorter [(289.1±57.9) s vs. (342.3±75.2) s] and less hemoglobin decreased after operation [(7.2±2.4) g/L vs. (11.4±2.1) g/L]. There was no difference in the deep vein patency and the incidence of PTS between the two groups at 3 , 12 and 24 months after operation. Conclusion:Pre-treatment with low dose urokinase before operation can improve the efficiency of PMT, effectively reduce the time of AngioJet activation and the destruction of red blood cells.

Objective:To explore the effect of mind mapping combined with scenario simulation teaching on probation teaching of abdominal trauma.Methods:The probation undergraduates from Batch 2017 five-year clinical medicine of Air Force Medical University were selected as research objects and randomly divided into experimental group ( n=98) and control group ( n=92). The experimental group was taught by mind mapping combined with scenario simulation teaching method, while the control group was taught by traditional teaching mode. After the end of the course, the effect of teaching was evaluated from two aspects: theoretical evaluation and teaching satisfaction evaluation. SPSS 19.0 was used for t test and chi-square test. Results:The results of theoretical test in the experimental group were significantly better than those of the control group [(84.03±8.99) vs. (78.53±8.97)], and the difference was statistically significant ( P<0.05). Compared with the control group, the experimental group had obvious advantages in learning interest, teamwork awareness and clear thinking, and achieved good teaching effect. Conclusion:Therefore, this teaching model helps to improve the teaching quality and provides some reference experience.

Objective To evaluate the laparoscopic splenectomy and pericardial devascularization in patients with portal hypertension.Methods In this study,205 patients who underwent splenectomy and pericardial devascularization in the Second Hospital of Air Force Medical University between Jan 2013 and Jan 2018 were divided into 135 patients undergoing laparoscopic surgery(LSD group) and 70 patients undergoing open surgery (OSD group).Results Operation time,intraoperative blood loss,intraoperative blood infusion,time of postoperative abdominal drainage-tube removal,time of gastrointestinal function recovery and duration of hospital stay were respectively (150 ± 37) min,(223 ± 129) ml,(91 ± 138) ml,(4.0 ± 1.0)d,(33 ±9)h,(5.6 ± 1.0)d in the LSD group,(183 ±42) min,(346 ± 131) ml,(214 ± 182) ml,(5.5 ± 1.3)d,(42 ± 14)h,(7.5 ± 1.4)d in the OSD group,with statistically significant differences between groups(t =-2.203,-4.980,-2.830,-5.553,-2.307,-6.635,all P ＜ 0.05).The main complications included pancreatic fistula,intra-abdominal bleeding,intra-abdominal infection,pulmonary infection,refractory ascites,portal vein system thrombosis and incision infection,and there were respectively 0,1,2,2,3,13,0 in the LSD group and 3,4,6,6,7,14,3 in the OSD group,with statistically significant differences between groups (x2 =5.872,4.792,6.179,6.179,6.010,4.335,5.872,all P ＜ 0.05).All the 205 patients received follow-up for a median time of 38 months (12-72 months).Gastroscopy showed improvement of esophageal and gastric varices in postoperative 6 months.Conclusion Laparoscopic splenectomy and pericardial devascularization for the treatment of portal hypertension is safe,feasible and effective.

Objective:To establish a risk prediction model of conversion to open surgery during laparoscopic splenectomy and esophagogastric devascularization (LSED) and evaluate the impact of this conversion on patients' short-term prognosis.Methods:A total of 358 cirrhotic portal hypertension patients admitted to the Department of General Surgery , Second Affiliated Hospital, Air Force Military Medical University from Feb 2011 to Nov 2020 were retrospectively analyzed. All patients underwent attempted LSED. Univariate and least absolute shrinkage and selection operator (LASSO) Logistic regression were used to analyze the independent risk factors for conversion to laparotomy, and the R language was used to build a nomogram prediction model for conversion to laparotomy. The intraoperative and postoperative conditions of the two groups were compared.Results:A total of 358 patients were included in this study, of which 31(8.7%). patients were converted to open surgery. In univariate analysis, high MELD score, BMI ≥24 kg/m 2, history of upper abdominal surgery, red sign of the varicose, low platelet count and prolonged PT are risk factors for conversion . LASSO regression finally identified 5 factors: MELD, BMI, PLT, history of surgery, and red sign. In the nomogram prediction model the area under ROC curve was 0.831. The conversion led to longer operation time; increased blood loss; prolonged postoperative abdominal drainage , longer hospital stay, and increased perioperative complications ( t=-2.167, P=0.031; Z=-4.350, P<0.01; Z=-3.102, P=0.002; Z=-3.454, P=0.001; χ2=8.773, P=0.003). Conclusions:LASSO regression selected five indicators with greatest impact on intraoperative conversion: MELD, BMI, PLT, red sign, and previous history of abdominal surgery. The nomogram prediction model established has good prediction ability. Patients converted to open surgery had worse short-term outcomes.